PBHCI Grantee Monthly Webinar: Making HIT Decisions

1. PBHCI Grantee Monthly Webinar: Making HIT Decisions Mike Lardiere Vice President HIT and Strategic Development Center for Integrated Health Solutions Jeremy Nelson Afia Inc. CEO

2. Presentation Outline • Introduction-Objectives • Backdrop: EHR Challenges • A Novel Approach To EHR Selection

3. Presentation Objective Provide a roadmap for planning and executing a successful EHR selection project, and to introduce a new web-based program to help get you there.

4. News Flash…familiar theme? Tackling the EMR with Planning and Preloading November 11, 2010 | Molly Merrill, Associate Editor “There is about a 50 percent failure rate for electronic medical record implementations, and most of those failures stem from poor planning and preparation.” -Scott Patch, MD → InterMED, P.A. (multi-specialty clinic Yarmouth, ME) http://www.healthcareitnews.com/news/tackling-emr-planning-and-preloading

5. Why? EHRs represent a significant capital investment EHRs are time consuming to select/implement EHRs are disruptive to healthcare operations EHR projects are tech-heavy and complex Most organizations lack EHR experience From the 2008 NEJM survey → 39% say “capacity to select and implement” is a major barrier to purchase. (http://www.nejm.org/doi/full/10.1056/NEJMsa0802005)

6. Conclusion Healthcare providers need help! A cost-effective program with expert assistance to help them to prepare for and select EHRs!

7. What You Don’t Know… Will hurt you! • Preparation and Planning • Organization and People • Technology and Workflow Assessment • Capital Assessment • Evaluation and Selection

8. Prepare and Plan A common mistake many organizations make is to underestimate the complexity involved and time required to undergo a transition to an EHR.

9. Organization & People Do you have a clinical leader? Do you have a project manager? Do you have an EHR project team? Are your key stakeholders on board? Why are you buying an EHR? Staff readiness → survey everyone? Project timeline?

10. Technology & Workflow Assessment Should you keep your billing system? Have you thought about implementation options? What about EHR network hosting? Thoughts about provider and nursing data entry? Do you have a paper chart transition plan? How will you manage incoming paper documents? Managing prescriptions… Billing and coding decisions… Device connectivity alternatives… Software purchase planning…so many options Hardware purchase planning…techno black-hole

11. Capital Assessment Expense estimates…do you know all of your costs? Are you aware of all of your revenue improvement and cost reduction opportunities? Can you calculate an ROI and payback period? Do you have a capital plan?

12. Evaluation and Selection How do you create a shortlist of (3-5) EHRs from the list of available vendors option? Are you prepared to create an RFP? Do you have a standard product demo script? How will you evaluate your reference site visit? Do you have a methodology for determining a final vendor of choice? Do you have experience negotiating large, complex software and service agreements?

13. Most Common Mistakes • No plan and no process… • Insufficient allocation of time to manage project… • Moving ahead without a clinical leader… • Lack of organizational involvement or consensus… • Engaging EHR vendors prior to planning… • Lack of experienced selection expert in process…

14. Phases of Implementation

15. EHR Prep-SelectTMProgram Optimal mix of… Innovative web-based EHR project management tool Comprehensive, yet intuitive and easy to use-follow A proven remote delivery methodology with expert oversight Affordable pricing Resulting in… Increased confidence and reduced pre-selection anxiety Decreased time to EHR vendor-of-choice decision Increased probability of selecting an appropriate vendor and a successful system implementation Increased ROI and improved pay-back period

16. Phase I: Preparation Step 1: Organizational Readiness • Project Objectives • Provider and Staff Readiness • Project Timing • The American Reinvestment and Recovery Act (ARRA) and Meaningful Use Step 2: Personnel Planning • IT Committee and Project Staffing • IT Project Committee

17. Step 3: Technology and Workflow Planning • Practice Management Strategy • Implementation Strategy • Hosting Strategy • Transition of Paper Charts • Provider and Nursing Data Entry • Device Connectivity • Prescription Writing • Billing and Coding • Document Management • Patient Registration • Software Purchase Planning • Hardware Purchase Planning

18. Step 4: EHR Capital Planning • EHR Expense Estimate • Revenue Improvements and Cost Reductions • Return on Investment Phase II: Building A Plan Step 5: Summarizing Practice Requirements • Your EHR Plan Step 6: Narrowing the List • Creating a Short List

19. Phase III: Selection Step 7: Vendor Solicitations and Product Demonstrations • Request for Proposals • Product Demonstrations Step 8: Reference Checking and Site Visits • Guidelines • Complete Reference Checking • Phone Reference Checking • Site Visit Agenda Step 9: Pricing and Product Comparison • RFP and Pricing Comparison • Vendor Scorecard

20. Define Requirements for your Unique Needs • This is the most important step for ensuring the system will meet your organization’s needs • Functional requirements will help to determine what current business functions, service areas, or future initiatives the system needs to support

21. What Requirements Should we Focus On? • Functional • These requirements describe what functions of the system • Ability to scan/image insurance cards and driver licenses • Ability for real-time interface with disease registry system • Technical • Requirements specific to needed or supported technology • System should be restored within <<x hrs>> of system failure • System must provide role-based security • General • Requirements about vendor size, clients, and relationship • Vendor has been in business at least 5 years • Vendor will put source code in escrow in case of dispute

22. Apply Knockout Criteria What are knockout criteria? • A subset of critical functions necessary to support your system • These “showstoppers” should be indisputably answered with a true or false • Examples • System must be web-enabled • System must have the ability to support integrated health services (or DD, SA, etc.) • System must allow customer customizations How are the knockout criteria used? • Allows you to narrow down which vendors will receive the RFP • Saves a great deal of time in continued analysis of the different EHRs • Vendors will save time by responding to RFPs where they fit

23. Workflow Analysis/Redesign What does workflow analysis mean for behavioral health? • Identify all of the functional areas you cover • Prioritize the existing business processes the EHR will support • Review high-level processes • Review current state and accreditation regulations to see what rules still apply • Verify the documentation of rules • Don’t be afraid to keep asking “Why?”

24. Map your Organization • Begin with an organization model to identify all key business areas • Use this list to determine high-level workflows of key processes • Some examples are:

25. Example Process Flow Diagram

26. Use the Request for Proposal to MatchVendor Systems to Requirements

27. Step 10: Contract Negotiation • Quotation and Purchase Agreements • Basic Negotiating Principles

28. Contact Center for Integrated Health Solutions Mike Lardiere Vice President HIT and Strategic Development mikel@thenationalcouncil.org 202-684-7457 x 273

29. Past CIHS webinar recordings Past CIHS webinars are recorded and archived on this page: http://www.thenationalcouncil.org/cs/resources_services/resource_center_for_healthcare_collaboration/training/webinars